More than 100 children have lost their lives in Muzaarpur this summer from acute encephalitis syndrome (AES). The government and administration have tried to blame varied causes like hypoglycaemia (sudden fall in blood sugar), heat wave, and inadequate intensive care units (ICU) in hospitals. The admission of failure has been left unsaid and left to wisdom of people. The administration has failed to respond to an annual outbreak of encephalitis, that has affected 11 districts, including Muzaarpur, with seasonal regularity. While symptoms of Japanese encephalitis (JE) and AES are similar —inflammation of the membrane of the brain that leads to sudden-onset fever, headache, disorientation, tremors, convulsions, and paralysis, but the causative agent is different. Vaccine-preventable JE is a mosquito-borne a virus from the same genus as dengue and yellow fever viruses.
AES may be caused by a range of factors, including toxins in unripe lychee fruit, viruses, bacteria, fungi, parasites and chemical poisons. If not treated within hours of appearing, 30% of the patients affected die. In India, AES outbreaks in the past in Muzaarpur have been linked to young, malnourished children eating unripe lychee fruit. Unripe lychees contain the toxins, hypoglycin A and and methylenecyclopropyl-glycine (MCPG) that cause vomiting and a sudden drop in blood sugar. In severely malnourished children, rapid fall in blood glucose levels can kill within hours. India has a standard operating JE/AES containment procedure, which mandates grassroots health workers, including auxiliary nurse-midwives, accredited social health activists, and anganwadi workers, to do household surveys to check children for JE/AES symptoms. If children with sudden fever are referred within hours of developing symptoms as mandated, simple glucose is all that is needed to save many young live.
With the death of six more children on Monday, Acute Encephalitis Syndrome (AES) has so far claimed the lives of 103 children in Muzaffarpur and its adjoining areas in north Bihar, the Muzaffarpur district magistrate said. Of these, 85 children died at Sri Krishna Medical College and Hospital (SKMCH), and 18 children at Kejriwal Maternity Clinic since the outbreak of AES, which causes inflammation of the membrane of the brain that leads to sudden onset fever that can cross 104 degrees F, headache, disorientation, tremors, convulsions and paralysis. If the symptoms are not treated within hours of the first few appearing, 30% of those affected die. AES usually affects very young children who are severely malnourished. “This year has been the worst outbreak of encephalitis cases in the state. Many of the children with the symptoms of AES or JE [Japanese Encephalitis] notably reported convulsion coupled with high fever died of hypoglycaemia, a condition of low blood sugar,” said Dr Gopal Shankar Sahni, the head of paediatric department, SKMCH, where most of the children with AES are being treated.
The deaths were confirmed by SKMCH superintendent, Sunil Kumar Shahi, and civil surgeon, Dr S P Singh. Chairing a high-level meeting to take stock of situation, chief minister Nitish Kumar announced on Monday that the government would bear the cost of treatment and also reimburse transport charges incurred in ferrying patients referred by primary health centres (PHCs). Facing Opposition flak, chief minister convened a review meeting of health, disaster and education departments immediately after his arrival to the state capital from Delhi.
Bihar’s already fragile health care system has been further hit by a doctors’ protest in support of the 24-hour nation-wide strike call by Indian Medical Association (IMA) on Monday in solidarity with their colleagues in West Bengal. AES cases have also been reported from Samastipur, East Champaran and Vaishali. “Eleven children with AES have so far been admitted at our health facilities in Samastipur and Vaishali each. Another six cases are admitted in East Champaran,” Manoj Kumar, executive director of Bihar’s State Health Society, said.
Bihar’s industry minister, Shyam Rajak, and several leaders from the Janata Dal (United) visited children being treated for AES in SKMCH wards. Bihar CM Kumar had earlier announced an ex-gratia compensation of ₹4 lakh each to families of deceased children.
Union health minister Harsh Vardhan on Monday directed another high-level multi-disciplinary team of experts to be sent to Bihar to establish the cause of disease.He also directed the state government to establish a 100-bed paediatric intensive care unit (ICU) at SKMCH. The state will also come up with five virological labs in different districts within a year.
Social worker, Tamanna Hashmi, has lodged a complaint case with the Chief Judicial Magistrate (CJM), Surya Kant Tiwary, against the Union Health Minister Vardhan, and Bihar Health Minister, Mangal Pandey, for negligence resulting in the deaths of more than 100 children; apathy in launching awareness campaigns; and flipflops in starting medical research to identify the viruses and other causes that have led to death of children. The CJM heard the complaint and fixed June 24 as the date for the next hearing.